04 August 2009

Economist Arthur Laffer (yeah, the supply-side guy) appeared on CNN to talk about health care reform:

He said "If you like the Post Office and the Department of Motor Vehicles and you think they’re run well, just wait till you see Medicare, Medicaid and health care done by the government."

Take a moment. Think about it. Get it?

I can only assume that, Laffer being a famous economist, this was not a moment of cluelessness, but an extremely subtle homage to an anecdote Obama recently told:

"I got a letter the other day from a woman. She said, 'I don't want government-run health care. I don't want socialized medicine. And don't touch my Medicare,'" Obama said at an AARP-hosted town hall on health care. The crowd laughed. "I wanted to say, you know, that's what Medicare is: a government-run health care plan that people are very happy with."

See, it's funny, because Medicare is run by the government. And it's run well, like many other government programs. It has lower administrative overhead and patients are highly satisfied with their coverage and access to care. For that matter, I like the post office, too. I can get something delivered across the country in a couple of days for next to nothing, they deliver all my bills on time, and I can stop & start my mail over the internet. FedEx and UPS are great, but a lot more expensive.

It's a straw man, anyway, because the government isn't getting into the health care delivery business. Conservatives can decry "government-run health care," and "socialism" all they want, but that doesn't make it so. All that is really being proposed is increased government regulation of insurers and, possibly, another government-run insurance program. Considering that the government has been doing that for decades, and doing a pretty good job of it by all measures, it sounds like something to be embraced, not feared.

Sorry Scalpel - you can't go back to "Keep Cool with Coolidge". Get used to the government getting more and more involved. Shadowfax, I personally hate the post office - I send everything except letters via UPS now...

C'mon ERP, the lines aren't THAT long, and the friendly federal employees are always willing to do whatever it takes to make their customers satisfied...what's not to like? You can't really expect them to rush or multitask...they are salaried for gosh sake. If you guys get your wish, going to the doctor will be just like that. And we'll all live happily ever after.

Shadowfax, when are you guys going to stop peddling the absurd myth that Medicare has lower admin costs than private insurance? Two good pieces on this issue can be found here and here.

To avoid thinking about their arguments, you'll no doubt dismiss the authors as tools of Richard Mellon Scaife or accuse them of being the illegitimate children of Sarah Palin and Dick Cheney, but their points are pretty much irrefutable.

While I find your energetic defense of your views laudable, I suggest that more reputable sources than the Heritage Foundation and Cato will be needed to convince me that water is in fact, not wet. Their points are irrefutable only inasmuch as you agree that their data and methods are honest, accurate, and unbiased. Unfortunately, I believe The Heritage Foundation has no less of a bias than, say, PNHP might from your perspective. It's a tough pickle we are in, you and I, in that we are both interested in this important debate, yet we each view the other's data sets as fundamentally untrustworthy. If only there were a neutral arbiter that we could both trust. There is one - the CBO - and it has opined in the past that Medicare is more cost-effective than private insurers, but I do concede that it did not look at the interesting and important question of whether cost per beneficiary is lower in the private sector.

I have not seen a good rebuttal of the Medicare vs Medicare Advantage comparison, however.

Medicare's costs are not the problem. They are a symptom. Health care inflation is the problem, and it has been shown to be significantly worse in the private sector. You could argue that taking all health insurance into the government would help restrain further cost escalation, but the "public plan" would only cover about 8-10 million Americans as currently proposed. So the cost savings from a public plan, depending on whom you believe, would be somewhere between modest and nonexistent.

I agree that costs need to be controlled. It seems to be a tough problem. The proposed plans make some effort to address them, but probably (certainly?) do not go far enough. Got any bright ideas to bend the cost curve, without painful compromises? If you do, please send them to this guy -- he can use some help.

I am curious as to your thoughts that Medicaid and Medicare are well run by the gov't. Those of us in primary care have found that we actually lose money by seeing Medicaid patients (and to some extent, Medicare as well). In fact, in pediatrics, when I factor in the costs of the nurses and clinic and vaccines (and don't include payment to doctor), I end up behind about $1. Although $1 does not seem like much, over the course of a year, that adds up to a lot, and remember, it's only a dollar if I assume I do not get paid to see that patient. Many of our local practices have had to severely limit how many Medicaid patients they can accept in order to keep their practices open. With these type of real life issues, how is Medicaid a gov't success story?

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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